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Imboumy-Limoukou RK, Lendongo-Wombo JB, Nguimbyangue-Apangome AF, Biteghe Bi Essone JC, Mounioko F, Oyegue-Libagui LS, Ngoungou BE, Lekana-Douki JB. Severe malaria in Gabon: epidemiological, clinical and laboratory features in Amissa Bongo Hospital of Franceville. Malar J 2023; 22:88. [PMID: 36894964 PMCID: PMC9996888 DOI: 10.1186/s12936-023-04512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Malaria is the most deadly parasitic disease and continues to claim more than a half million of deaths across the world each year, mainly those of under-fives children in sub-Saharan Africa. The aim of this study was to determine the epidemiological, clinical and laboratory features of patients with severe malaria at the Centre Hospitalier Régional Amissa Bongo (CHRAB), a referral hospital in Franceville. METHODS It was an observational descriptive study conducted at CHRAB over 10 months. All admitted patients at the emergency ward of all ages presenting with positive test to falciparum malaria diagnosed by microscopy and rapid test with clinical signs of severe illness describe by World Health Organization were enrolled. RESULTS During this study, 1065 patients were tested positive for malaria, of them 220 had severe malaria. Three quarters (75.0%) were less than 5 years of age. The mean time to consultation was 3.5 ± 1 days. The most frequent signs of severity on admission were dominated by neurological disorders 92.27% (prostration 58.6% and convulsion 24.1%), followed by severe anemia 72.7%, hyperlactatemia 54.6%, jaundice 25% and respiratory distress 21.82%.The other forms such as hypoglycemia, haemoglobinuria, renal failure were found in low proportions < 10%. Twenty-one patients died, coma (aOR = 15.54, CI 5.43-44.41, p < 0.01), hypoglycemia (aOR = 15.37, CI 2.17-65.3, p < 0.01), respiratory distress (aOR = 3.85, CI 1.53-9.73, p = 0.004) and abnormal bleeding (aOR = 16.42, CI 3.57-104.73, p = 0.003) were identified as independent predictors of a fatal outcome. Anemia was associated with decreased mortality. CONCLUSION Severe malaria remains a public health problem affecting mostly children under 5 years. Classification of malaria helps identify the most severely ill patients and aids early and appropriate management of the severe malaria cases.
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Affiliation(s)
- Roméo Karl Imboumy-Limoukou
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon.
| | - Judicael Boris Lendongo-Wombo
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon.,Ecole Doctorale Régionale d'Afrique Centrale en Infectiologie Tropicale (ECODRAC), Université Des Sciences Et Techniques de Masuku, BP 876, Franceville, Gabon.,Département d'épidémiologie, Biostatistiques Et Informatique Médicale, Université Des Sciences de La Santé (USS), BP 18231, Libreville, Gabon
| | - Andhra Fecilia Nguimbyangue-Apangome
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon
| | - Jean-Claude Biteghe Bi Essone
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon
| | - Franck Mounioko
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon.,Département de Biologie, Université Des Sciences Et Techniques de Masuku (USTM), BP 901, Franceville, Gabon
| | - Lydie Sandrine Oyegue-Libagui
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon.,Ecole Doctorale Régionale d'Afrique Centrale en Infectiologie Tropicale (ECODRAC), Université Des Sciences Et Techniques de Masuku, BP 876, Franceville, Gabon.,Département de Biologie, Université Des Sciences Et Techniques de Masuku (USTM), BP 901, Franceville, Gabon
| | - Brice Edgar Ngoungou
- Département d'épidémiologie, Biostatistiques Et Informatique Médicale, Université Des Sciences de La Santé (USS), BP 18231, Libreville, Gabon
| | - Jean-Bernard Lekana-Douki
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon.,Département de Parasitologie-Mycologie, Université Des Sciences de La Santé, BP 18231, Libreville, Gabon
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Nzoumbou-Boko R, Velut G, Imboumy-Limoukou RK, Manirakiza A, Lekana-Douki JB. Malaria research in the Central African Republic from 1987 to 2020: an overview. Trop Med Health 2022; 50:70. [PMID: 36131331 PMCID: PMC9490699 DOI: 10.1186/s41182-022-00446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022] Open
Abstract
Background The national malaria control policy in the Central African Republic (CAR) promotes basic, clinical, and operational research on malaria in collaboration with national and international research institutions. Preparatory work for the elaboration of National Strategic Plans for the implementation of the national malaria control policy includes developing the research component, thus requiring an overview of national malaria research. Here, this survey aims to provide an inventory of malaria research as a baseline for guiding researchers and health authorities in choosing the future avenues of research. Methods Data sources and search strategy were defined to query the online Medline/PubMed database using the “medical subject headings” tool. Eligibility and study inclusion criteria were applied to the selected articles, which were classified based on year, research institute affiliations, and research topic. Results A total of 118 articles were retrieved and 51 articles were ultimately chosen for the bibliometric analysis. The number of publications on malaria has increased over time from 1987 to 2020. These articles were published in 32 different journals, the most represented being the Malaria Journal (13.73%) and the American Journal of Tropical Medicine and Hygiene (11.76%). The leading research topics were drug evaluation (52.94%), expatriate patients (23.54%), malaria in children (17.65%), morbidity (13.7%), and malaria during pregnancy (11.76%). The publications’ authors were mainly affiliated with the Institut Pasteur of Bangui (41%), the French Military Medical Service (15.5%), and the University of Bangui (11.7%). Collaborations were mostly established with France, the UK, and the USA; some collaborations involved Switzerland, Austria, Pakistan, Japan, Sri Lanka, Benin, Cameroun, Ivory Coast, and Madagascar. The main sources of research funding were French agencies (28.6%) and international agencies (18.3%). Most studies included were not representative of the whole country. The CAR has the capacity to carry out research on malaria and to ensure the necessary collaborations. Conclusion Malaria research activities in the CAR seem to reflect the priorities of national policy. One remaining challenge is to develop a more representative approach to better characterize malaria cases across the country. Finally, future research and control measures need to integrate the effect of COVID-19.
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Affiliation(s)
- Romaric Nzoumbou-Boko
- Laboratoire de Parasitologie, Institut Pasteur de Bangui, PO Box 923, Bangui, Central African Republic.
| | - Guillaume Velut
- French Military Health Service, French Armed Forces Centre for Epidemiology and Public Health (CESPA), Marseille, France
| | - Romeo-Karl Imboumy-Limoukou
- Unité Évolution, Épidémiologie Et Résistances Parasitaires (UNEEREP), Centre International de Recherche Médicale de Franceville (CIRMF), BP769, Franceville, Gabon
| | - Alexandre Manirakiza
- Service d'épidémiologie, Institut Pasteur de Bangui, PO Box 923, Bangui, Central African Republic
| | - Jean-Bernard Lekana-Douki
- Unité Évolution, Épidémiologie Et Résistances Parasitaires (UNEEREP), Centre International de Recherche Médicale de Franceville (CIRMF), BP769, Franceville, Gabon.,Département de Parasitologie-Mycologie Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, Libreville, B.P. 4009, Franceville, Gabon
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Chiabi A, Djimafo ANM, Nguefack S, Mah E, Nguefack Dongmo F, Angwafo F. Severe malaria in Cameroon: Pattern of disease in children at the Yaounde Gynaeco-Obstetric and Pediatric hospital. J Infect Public Health 2020; 13:1469-1472. [DOI: 10.1016/j.jiph.2020.02.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/28/2019] [Accepted: 02/05/2020] [Indexed: 10/24/2022] Open
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Mutombo AM, Mukuku O, Tshibanda KN, Swana EK, Mukomena E, Ngwej DT, Luboya ON, Kakoma JB, Wembonyama SO, Van Geertruyden JP, Lutumba P. Severe malaria and death risk factors among children under 5 years at Jason Sendwe Hospital in Democratic Republic of Congo. Pan Afr Med J 2018; 29:184. [PMID: 30061962 PMCID: PMC6061819 DOI: 10.11604/pamj.2018.29.184.15235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/13/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Malaria is still a major public health concern in the Democratic Republic of Congo. Its morbidity and mortality challenge the actual strategies of the fight agains malaria. This study was aimed to describe the epidemiology, the clinical caracteristics and the risk factors of death associated to severe malaria in the pediatric population under 5 years at Sendwe Hospital of Lubumbashi. METHODS This analytical retrospective study was conducted in Lubumbashi, in the province of Haut-Katanga. All patients under 5 years hospitalized for severe malaria were registered from January 2014 to December 2016. RESULTS Among the 3,092 patients hospitalised during our study period, 452 (14.6%) were admitted for severe malaria. The average age was 27.04 months, the male sex was the most affected (53.54% with the sex-ratio 1.15). The most frequent forms of gravity noticed were cerebral malaria (48.23%) and severe anemia (46.90%). Death was noted in the evolution in 28.32%. Repeated convulsion (OR = 2.27; 95% CI: 1.47-3.48), coma (OR = 3.55; 95% CI: 2.19-5.74) and severe acute malnutrition (OR = 3.32; 95% CI: 1.56-7.06) were asscociated with a high risk of death. CONCLUSION This research shows that severe malaria is still an important cause of morbidity and mortality among young children in Lubumbashi. Neurologic and anemic forms are the most frequent. The predictive signs of death are: repeated convulsions, coma and severe acute malnutrition.
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Affiliation(s)
- Augustin Mulangu Mutombo
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Olivier Mukuku
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Kristel Nzeba Tshibanda
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Edouard Kawawa Swana
- Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Eric Mukomena
- Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Dieudonné Tshikwej Ngwej
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Oscar Numbi Luboya
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Jean-Baptiste Kakoma
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | | | | | - Pascal Lutumba
- Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
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Kunuanunua TS, Nsibu CN, Bodi JM, Tshibola TK, Makusi Bura M, Magoga K, Ekila MB, Situakibanza HT, Aloni MN. Severe malaria in children: A descriptive report from Kinshasa, the Democratic Republic of Congo. J Trop Pediatr 2015; 61:272-8. [PMID: 25957436 DOI: 10.1093/tropej/fmv029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The decline of susceptibility of Plasmodium falciparum to chloroquine and sulfadoxine-pyrimethamine resulted in the change of drug policy. This policy has probably changed the facies of the severe form of malaria. A prospective study was conducted in Kinshasa, the Democratic Republic of Congo. Data on children aged ≤13 years, diagnosed with severe malaria were analyzed. In total, 378 children were included with an overall median age of 8 years (age range: 1-13 years). Dark urine was seen in 25.1% of cases. Metabolic acidosis (85.2%), hypoglycemia (62.2%) and hemoglobin ≤5 g/dl (39.1%) were the common laboratories features. Severe malaria anemia, cerebral malaria and Blackwater fever (BWF) were found in 39.1, 30.1 and 25.4%, respectively. Mortality rate was 4%. BWF emerges as a frequent form of severe malaria in our midst. Availing artemisin-based combination treatments in the health care system is a priority to reduce the incidence of BWF in our environment.
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Affiliation(s)
- Thomas S Kunuanunua
- Division of Intensive Care, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo Department of Pediatrics, Hôpital Général de Référence de N'djili, Institut Supérieur de Techniques Médicales, Kinshasa, Democratic Republic of Congo
| | - Célestin N Nsibu
- Division of Intensive Care, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Joseph M Bodi
- Division of Intensive Care, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Thérèse K Tshibola
- Department of Pediatrics, Hôpital Général de Référence de N'djili, Institut Supérieur de Techniques Médicales, Kinshasa, Democratic Republic of Congo
| | - Mimy Makusi Bura
- Department of Pediatrics, Hôpital Général de Référence de N'djili, Institut Supérieur de Techniques Médicales, Kinshasa, Democratic Republic of Congo
| | - Kumbundu Magoga
- Department of Pediatrics, Hôpital Général de Référence de N'djili, Institut Supérieur de Techniques Médicales, Kinshasa, Democratic Republic of Congo
| | - Mathilde B Ekila
- Division of Infectious Diseases, Department of Internal Medicine, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Hypolite T Situakibanza
- Division of Infectious Diseases, Department of Internal Medicine, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Michel N Aloni
- Division of Haemato-oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Manning L, Laman M, Davis WA, Davis TME. Clinical features and outcome in children with severe Plasmodium falciparum malaria: a meta-analysis. PLoS One 2014; 9:e86737. [PMID: 24516538 PMCID: PMC3916300 DOI: 10.1371/journal.pone.0086737] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/14/2013] [Indexed: 11/29/2022] Open
Abstract
Background Although global malaria mortality is declining, estimates may not reflect better inpatient management of severe malaria (SM) where reported case fatality rates (CFRs) vary from 1–25%. Methods A meta-analysis of prospective studies of SM was conducted to examine i) whether hypothesized differences between clinical features and outcome in Melanesian compared with African or Asian children really exist, and ii) to explore temporal changes in overall and complication-specific CFRs. The proportions of different SM complications and, overall and complication-specific CFRs were incorporated into the meta-analysis. Adjustments were made for study-level covariates including geographic region, SM definition, artemisinin treatment, median age of participants and time period. Findings Sixty-five studies were included. Substantial heterogeneity (I2>80%) was demonstrated for most outcomes. SM definition contributed to between-study heterogeneity in proportions of cerebral malaria (CM), metabolic acidosis (MA), severe anemia and overall CFR, whilst geographic region was a significant moderator in for CM and hypoglycemia (HG) rates. Compared with their African counterparts, Melanesian children had lower rates of HG (10% [CI95 7–13%] versus 1% [0–3%], P<0.05), lower overall CFR (2% [0–4%] versus 7% [6–9%], P<0.05) and lower CM-specific CFR (8% [0–17%] versus 19% [16–21%], P<0.05). There was no temporal trend for overall CFR and CM-specific CFR but declining HG- and MA- specific CFRs were observed. Interpretation These data highlight that recent estimates of declining global malaria mortality are not replicated by improved outcomes for children hospitalized with SM. Significant geographic differences in the complication rates and subsequent CFRs exist and provide the first robust confirmation of lower CFRs in Melanesian children, perhaps due to less frequent HG.
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Affiliation(s)
- Laurens Manning
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
- * E-mail:
| | - Moses Laman
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Wendy A. Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Timothy M. E. Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
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Ossou-Nguiet PM, Okoko AR, Ekouya Bowassa G, Oko AP, Mabiala-Babela JR, Ndjobo Mamadoud IC, Moyen G. [Determinants of cerebral malaria in Congolese children]. Rev Neurol (Paris) 2013; 169:510-4. [PMID: 23394850 DOI: 10.1016/j.neurol.2012.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 11/01/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Abstract
Malaria still constitutes a worrying problem of public health. It remains an important cause of infant mortality. To determine the determinants of severe malaria a case control study was carried out from July to December 2011 in the pediatric intensive care department of the university hospital of Brazzaville. The group included 230 children hospitalised for severe malaria, and the control group consisted of children followed up for non-severe malaria. Cases and controls were compared using statistical tests for matched group. The young age of the mother (OR=4.13), her poor education level (OR=2.36), the low socioeconomic level of parents (OR=5.90), the malnutrition (OR=2.67), the delay of consultation (OR=13.69) and parasitemia were associated with significantly higher risk of severe malaria. The importance of identified determinants imposes the implementation of primary prevention measures, which pass through the amelioration of socioeconomic and cultural conditions of populations, the reinforcement of sanitary education, and also a secondary prevention consisting of an early and accurate management of ordinary malaria.
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Affiliation(s)
- P M Ossou-Nguiet
- Service de neurologie, université de Brazzaville, CHU de Brazzaville, 13, boulevard Maréchal-Lyautey, BP 32, Brazzaville, Congo.
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Losimba Likwela J, D’Alessandro U, Donnen P, Wilmet Dramaix M. Clinical aspects and outcome of suspected severe pediatric malaria. Med Mal Infect 2012; 42:315-20. [DOI: 10.1016/j.medmal.2012.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 12/23/2011] [Accepted: 05/16/2012] [Indexed: 11/16/2022]
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Abstract
BACKGROUND The practice of glycemic control with intravenous insulin in critically ill patients has brought clinical focus on understanding the effects of hypoglycemia, especially in children. Very little is published on the impact of hypoglycemia in this population. We aimed to review the existing literature on hypoglycemia in critically ill neonates and children. METHODS We performed a systematic review of the literature up to August 2011 using PubMed, Ovid MEDLINE and ISI Web of Science using the search terms "hypoglycemia or hypoglyc*" and "critical care or intensive care or critical illness". Articles were limited to "all child (0-18 years old)" and "English". RESULTS A total of 513 articles were identified and 132 were included for review. Hypoglycemia is a significant concern among pediatric and neonatal intensivists. Its definition is complicated by the use of a biochemical measure (i.e., blood glucose) for a pathophysiologic problem (i.e., neuroglycopenia). Based on associated outcomes, we suggest defining hypoglycemia as <40-45 mg/dl in neonates and <60-65 mg/dl in children. Below the suggested threshold values, hypoglycemia is associated with worse neurological outcomes, increased intensive care unit stay, and increased mortality. Disruptions in carbohydrate metabolism increase the risk of hypoglycemia incritically ill children. Prevention of hypoglycemia, especially in the setting of intravenous insulin use, will be best accomplished by the combination of accurate measuring techniques, frequent or continuous glucose monitoring, and computerized insulin titration protocols. CONCLUSION Studies on hypoglycemia in critically ill children have focused on spontaneous hypoglycemia. With the current practice of maintaining blood glucose within a narrow range with intravenous insulin, the risk factors and outcomes associated with insulin-induced hypoglycemia should be rigorously studied to prevent hypoglycemia and potentially improve outcomes of critically ill children.
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